Kim C, Christophi C A, Goldberg R B, Perreault L, Dabelea D, Marcovina S M, Pi-Sunyer X, Barrett-Connor E
Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
Biostatistics Center, George Washington University, Rockville, MD, USA.
Diabet Med. 2016 Jan;33(1):32-8. doi: 10.1111/dme.12799. Epub 2015 May 29.
To examine concentrations of biomarkers (adiponectin, C-reactive protein, fibrinogen and tissue plasminogen-activator antigen) associated with glucose homeostasis and diabetes risk by history of gestational diabetes (GDM).
We conducted a secondary analysis of the Diabetes Prevention Program, a randomized trial of lifestyle intervention or metformin for diabetes prevention. At baseline, participants were overweight and had impaired glucose tolerance. Biomarkers at baseline and 1 year after enrolment were compared between parous women with (n = 350) and without histories of GDM (n = 1466). Cox proportional hazard models evaluated whether history of GDM was associated with diabetes risk, after adjustment for baseline biomarker levels as well as for change in biomarker levels, demographic factors and anthropometrics.
At baseline, women with histories of GDM had lower adiponectin (7.5 μg/ml vs. 8.7 μg/ml; p < 0.0001) and greater log C-reactive protein (-0.90 mg/l vs. -0.78 mg/l, p = 0.04) levels than women without histories of GDM, but these associations did not persist after adjustment for demographic factors. Fibrinogen and tissue plasminogen-activator antigen were similar between women with and without histories of GDM. Women with and without histories of GDM had a similar pattern of changes in biomarkers within randomization arm. Adjustment for age, race/ethnicity, baseline weight, change in weight, baseline biomarker level and change in biomarker level did not significantly alter the association between history of GDM, and diabetes risk.
Among women with impaired glucose tolerance, biomarkers in women with and without histories of GDM are similar and respond similarly to lifestyle changes and metformin. Adjustment for biomarker levels did not explain the higher risk of diabetes observed in women with histories of GDM.
根据妊娠期糖尿病（GDM）病史，检测与葡萄糖稳态及糖尿病风险相关的生物标志物（脂联素、C反应蛋白、纤维蛋白原和组织纤溶酶原激活物抗原）的浓度。
我们对糖尿病预防计划进行了二次分析，这是一项关于生活方式干预或二甲双胍预防糖尿病的随机试验。在基线时，参与者超重且糖耐量受损。比较了有GDM病史（n = 350）和无GDM病史（n = 1466）的经产妇在基线时和入组后1年的生物标志物。Cox比例风险模型评估了在调整基线生物标志物水平以及生物标志物水平变化、人口统计学因素和人体测量学因素后，GDM病史是否与糖尿病风险相关。
在基线时，有GDM病史的女性脂联素水平低于无GDM病史的女性（7.5μg/ml对8.7μg/ml；p < 0.0001），log C反应蛋白水平高于无GDM病史的女性（-0.90mg/l对-0.78mg/l，p = 0.04），但在调整人口统计学因素后，这些关联不再存在。有和无GDM病史的女性之间纤维蛋白原和组织纤溶酶原激活物抗原相似。有和无GDM病史的女性在随机分组组内生物标志物的变化模式相似。调整年龄、种族/民族、基线体重、体重变化、基线生物标志物水平和生物标志物水平变化后，GDM病史与糖尿病风险之间的关联没有显著改变。
在糖耐量受损的女性中，有和无GDM病史的女性生物标志物相似，对生活方式改变和二甲双胍的反应也相似。调整生物标志物水平并不能解释有GDM病史的女性中观察到的较高糖尿病风险。
